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Using Mixed-Reality for Free Flap Design: LTP and DIEP Perforator Identification
Nicolás M Kass, Sumaarg Pandaya, Shawn Loder, Elizabeth Moroni, Nikhil Sharma, Steve Canton, Jacob Biehl, Edward Andrews, Michael L Gimbel
University of Pittsburgh Medical Center
2024-01-15
Presenter: Nicolás M. Kass
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Improved anatomical understanding can lead to improved intraoperative decision making in perforator identification and flap design. Mixed reality (MR) allows three-dimensional renderings of CT data to be projected upon the donor site skin, allowing the surgeon to better visualize sub-surface anatomy. We aimed to assess the viability of this technology in both DIEP and LTP flap design.
Methods
The Medivis SurgicalAR system was used in conjunction with the Microsoft HoloLens 2, an AR/MR headset with a see-through visor. CT imaging was projected onto a patient undergoing a DIEP procedure. For the DIEP flap design, time and discrepancy of perforator location were assessed. Although an LTP flap was not performed, the location and course of the LTP perforator was visualized and used to draw a mock flap design.
Results
Registration error was estimated to be 2mm in the rostral-caudal axis on the right ASIS, 4mm in the rostral-caudal axis on the left ASIS, and <1mm on both umbilicus points in all directions. Registering the hologram to the patient lasted 77 seconds, flap outlining 62 seconds on the left and 40 seconds on the right. DIEP perforators were identified and traced in 21 seconds.
Discussion
We found our process to be highly accurate and efficient. Divergence from pre-operative CT due to soft tissue deformation did not impact the ability to localize perforators or outline flaps. This process and technology have the potential to improve flap design and elevate standard of care.
